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Incarcerated Ventral Hernia
For 2 days, a 79-year-old moderately obese woman had experienced abdominal pain, nausea, and vomiting. The pain was at the level of the incision for the colon cancer surgery she had undergone several years earlier. The patient was in mild distress. The central abdomen was tender; bowel sounds were high-pitched.
For 2 days, a 79-year-old moderately obese woman had experienced abdominal pain, nausea, and vomiting. The pain was at the level of the incision for the colon cancer surgery she had undergone several years earlier. The patient was in mild distress. The central abdomen was tender; bowel sounds were high-pitched. A CT scan performed to rule out metastatic cancer showed a herniated loop of intestine (yellow arrow) and dilatation of the bowel proximal to the hernia site (red arrow). These findings were consistent with an incarcerated ventral hernia.
Virendra Parikh, MD, of Fort Wayne, Ind, writes that ventral hernia can usually be diagnosed by an adequate physical examination. In obese persons, however, small to medium-sized hernias may be missed, and a CT scan of the abdomen is required. Prompt recognition and timely surgery can prevent bowel ischemia and strangulation of the bowel.
This patient's hernia was related to her previous surgery. Obesity was not a contributing factor in this case. She underwent an overlapping fascial repair of the hernia. There was no evidence of bowel ischemia of the incarcerated intestine.
